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Insurance claims.

Last week, in a tour de force of intellectual humility, Matthew J. Franck treatedFirst Things readers to a catalogue of my confusions. He didn't take kindly to my analysis of Cardinal Timothy Dolan's response to HHS's new proposals for the contraception mandate. First, Franck claims that I am "confused...about what the government actually announced." Second, he says that my analysis of the moral culpability of religious employers is unreliable because I am "confused about the economic reality of insurance." This confusion, Franck informed me via Twitter, is profound: He sees "no sign from you either of an argument, an ability to read, or an understanding of arithmetic." Given those impairments, I may not be able to formulate a successful response to Franck's confident critique, but I beg your indulgence as I give it a shot.

Let's start with the Franck's first complaint. Do I have the foggiest idea of what HHS actually announced? Here's how I summarized the latest proposals: "The new rule scotches the previous iterations much-maligned four-part definition of 'religious employer,' and proposes arrangements to make sure religious employers including colleges, hospitals, and charities wont have to pay for or refer for contraception coverage in their employee health plans." Later in the post, I wrote that "any religiously affiliated employer that has nonprofit status simply has to self-certify with HHS in order to opt out of the contraception mandate."

Franck alleges that I conflated the categories of religious employers proposed by HHS: "Gallicho fails to understand that the new, tax code-derived definition of 'religious employer' is perfectly irrelevant when it comes to the new second category, and insists, quite wrongly, that 'any religiously affiliated employer that has nonprofit status simply has to self-certify with HHS in order to opt out of the contraception mandate.'" But that isn't my only error, according to Franck. No, I've made "several mistakes at once":

First, the tax codes borrowed language does not apply to "any religiously affiliated employer that has nonprofit status,' but to a much tighter category of churches and their 'integrated auxiliaries." Second, the employers in the new second category who are nonprofits that 'hold themselves out as religious' do not get to 'opt out' at all, if by that is meant that their employees are not covered by the mandate; they get the new (essentially fake) "accommodation."

What is he talking about? When HHS floated its initial proposal for the contraception mandate, it counted as "exempt" only those employers that had religious inculcation as their purpose, that employed and served "primarily" co-religionists, and that operated as a nonprofit. I joined the bishops and many others in criticizing that definition of "religious employer."

A few weeks later, the Obama administration announced a new proposed rule that would "accommodate" religiously affiliated employers that failed to qualify for the narrowly defined exemption by allowing them not to include contraception coverage in employee health plans. Instead, the insurance company would offer employees of such institutions separate contraception coverage at no cost. (At the same time, the administration floated a series of complex arrangements that might address the situation of "self-insured" companies that pay directly for employees' medical care; those have been distilled in the latest HHS proposals.)

So, on the one hand there were "exempt" employers (dioceses, parishes, parish schools) -- their employees would not be eligible for the proposed free contraception coverage. And on the other hand there were "accommodated" institutions (hospitals, colleges, charities) -- they wouldn't have to contract for, pay for, or refer for contraception coverage, but their employees would be able to receive it at no cost from a third party. That difference is preserved -- but clarified in such a way that could expand the range of exempt employers -- in the most recent proposed rule, and that's what upsets Franck. He believes that there is a significant moral difference between a religious employer whose employees will not receive contraception coverage at all and a religious employer whose employees will receive contraception coverage from a third party. He thinks the only true "opt out" is available to fully exempt employers, whereas I see a moral significance in an "accommodated" employer's ability to choose not to contract for contraception coverage. I could have been clearer about this in my post, but in the final analysis, it makes little difference to the moral calculus because neither exempt nor accommodated institutions will have to include contraception coverage in their employee health plans. I agree with Bishop Robert Lynch that this arrangement amounts to "a distinction without difference." More on that in a moment.

Back to Franck: "When the Obama administration claims that employers will not 'fund' the contraceptive coverage provided by insurers," he alleges, "it speaks falsely." He continues:

When it [the Obama administration] claims that the free contraceptive coverage can be afforded by the insurer because cost-savings will result from improvements in womens health and fewer childbirths, the administration is admitting that the contraception is already being paid for by the employer, if its policy covers childbirth and womens health in general. The insurer is not being told to lower its premiums because of the cost-savings on procedures and ailments already covered; it is being told that it can put the cost-savings toward the expense of providing contraception. The existing premiums, paid by the employer, will be the funding source.

Leave aside, for the moment, the fact that actuarial studies have already shown that adding contraception coverage doesn't end up costing insurers extra -- it's not relevant to the moral question. What matters is who pays for it and why. Franck says that "the existing premiums, paid by the employer, will be the funding source." Unfortunately for his argument, that's not how health insurance works.

When a group like, say, EWTNpays monthly premiums to its insurance provider, the insurer does not take the money, deposit it in an account used only for the TV network's premiums, and then pay EWTN employees' medical bills out of that account. Rather, the insurer pools EWTN's payments with those from other customers. So when an EWTNemployee gets an X-ray, the money that pays the bill may or may not come from EWTN. It may come from a company whose insurance coverage includes abortion. The insurer's risk assessment of its policyholders determines whose monies fill the pools. If the same insurer covers EWTN and NARAL, the two organization's monies will be mingled. Indeed, it's the pooling of premiums that provides the incentive for insurers to offer contraception at no cost to their customers. (In 2002, the Kaiser Family Foundation published a useful primer on health insurance [.pdf]. If you have trouble getting your head around our strange health-insurance system, it's well worth reading.)

So, pace Franck, when it comes to determining who's really funding contraception for employees of accommodated organizations, "the existing premiums, paid by the employer" will not "be the funding source." It may be one of the funding sources. It may not. The point is, there's really no way to know, because insurance companies are in the business of spreading risk. It would be like trying to determine whether any of Matthew Franck's federal tax dollars ended up paying for an abortion for a rape victim. Once he's paid taxes, that money is no longer his. It's collected with other people's money and dispensed by someone else. He's not on the hook for what's done with that money unless he's willed something evil. That is, of course, the point of money. Did the change I got from Starbucks this afternoon come from a drug dealer? I don't know. Was the banana I had this morning picked by a child? I hope not, but did I try hard enough to find out? Did the money I saved by not buying organic cover life-saving medical treatment for a loved one? An electric bill? An iPad mini? The Catholic tradition accounts for the complexity of moral agency in a fallen world. We are never disentangled from sin. So the tradition helps us think through these difficult questions: What did I intend? What was the effect? Could it have happened without me?

Franck doesn't give those questions their due. He seems to suggest that every time someone pays an insurance company he has illicitly cooperated with evil, regardless of intent. After all, major insurers cover abortion for at least some of their customers. (Would he also say "self-insured" religious employers that engage the services of an insurance company to administer their health plans are morally culpable [most do]?) Franck says the latest contraception-mandate proposals are no good because they still involve religious employers in morally illicit arrangements. But everything the Obama administration has proposed is designed to distance the religious employer from the coverage it objects to. It frees religious employers from having to say, "Yes, I want to include contraception coverage in my employee health plan." It allows "self-insured" religious employers to say, "No, we won't pay for contraception out of the monies we've saved to cover our employees' medical care." It transfers responsibility to a third party. If an employee of an "accommodated" religious institution avails herself of the contraception provided by a third party, her employer is no more responsible than it would be were she to use her wages to purchase condoms. In the United States, benefits are considered part of an employee's compensation.

Franck is hung up on whether the HHS proposals will actually work, whether insurers will recoup the upfront costs of providing contraception, even to people who aren't in their risk pools. But who cares? For "self-insured" companies, not a dime from their health-care kitties will pay for contraception. For companies that pay insurance premiums, they won't have to contract or refer for contraception coverage. Might their premiums end up paying for services to which they have religious objections? Yes. But they already are. That they don't intend to fund such services is what frees them from moral culpability.

And that's precisely why I believe the latest proposals for the contraception mandate pass moral muster. If Franck wants to counter my moral argument, he'll have to acquire a clearer understanding of how insurance works.

Comments

You said I concluded "that insurance companies set rates without reference to what services are covered or not covered." I did not say that. That would be absurd. You alleged that I claimed "that increasing or reducing coverage is irrelevant to pricing isnt believable." I agree. That's why I didn't say anything of the sort. "Where do you suppose this money comes from?" According to the actuarial studies cited by HHS, it comes from the cost savings over the life of a policy. No one is claiming there is no upfront cost. Of course there is. The idea is that insurers will not lose money in the long run because pregnancies and babies are more expensive than no pregnancies and no babies. "Risk of what, one might ask? Risk of losing a job? Risk of being lost at sea?" How do you think insurers determine premium? They look at a patient or group's history, age, past medical costs, etc. -- all part of a patient's or group's risk profile -- and offer a range of pricing options accordingly. Lower deductibles for higher premiums. Vice versa. They don't arrive at a price simply by tallying covered services. "The fact that one cant trace the exact dollars is neither here nor there." It certainly is both here and there -- at least if one is interested in making a Catholic moral argument.

So what would you say about the purchase of insurance contracts that came with a separate provision for "free" euthanasia for one's child that gets too sick?The exact same defenses could be made:1) Euthanasia absolutely saves money for the health insurance company in the long term, and therefore can be provided in a separate "free" arrangement.2) Once your dollars flow into the insurance company, all money is fungible, so who knows whether your actual dollars were used to pay a doctor who actually performs euthanasia. Catholic moral arguments require tracing the exact dollars, and since this can't be done, you can buy an insurance policy that comes with a free rider for absolutely anything.

You're still misunderstanding the point: religious employers will not have to contract for contraception coverage. Catholic moral arguments certainly do not require "tracing the exact dollars," whatever that means. Someone is wrong online.

"religious employers will not have to contract for contraception coverage."OK, so imagine that someone generously says, "You don't have to contract for euthanasia coverage for your employees' or your own children if they get sick. We'll just add that in separately as a automatic accompaniment to the health insurance policy that you did buy. You don't need to do anything extra; euthanasia is free."Problem solved? No moral issue? "Catholic moral arguments certainly do not require tracing the exact dollars, whatever that means."Hmm. Within the space of 40 minutes, you went from saying that tracing exact dollars "certainly is both here and there" to make a Catholic moral argument, to saying that tracing exact dollars is "certainly" not necessary to a Catholic moral argument. The only thing I'm certain of is that you could be clearer on specifying a stable point of view.

Or, perhaps, risk of needing reimbursement for the services coveredThe accuracy of this statement is so self-evident that even someone with the weakest grasp of how insurance works can see it. So Im going to make like this is a prize fight, and stop it.

Try to focus on the actual policy, Mr. Time. If you want to make a slippery-slope argument then make one. I don't see euthanasia being covered by insurers (it's illegal in most states, for one thing, because the culture has not arrived at a moral consensus on euthanasia in the way it has on contraception).I don't know what "tracing exact dollars" means. A Catholic moral argument has to take account of several things: the intent of the moral agent, the effect of his act, whether that outcome would have been likely without his action. An accommodated employer does not will his employee to use contraception. The employer does not ask for contraception coverage. The employer pays premiums that are pooled with the premiums of other customers, many of whom have contracted for contraception. If the employer were to stop offering health benefits to his employees, those employees would seek coverage with spouses or on the state exchanges, where they will almost certainly receive contraception coverage. The employee is not required by anyone to use this coverage. If the employee does, it is not the employers fault. If the employee does not, it does not redound to the moral purity of the employer -- just as an employer cannot be blamed when an employee pays an abortion clinic with her wages. Continuing to offer employee health coverage is therefore licit remote material cooperation with evil under duress. Providing health coverage to employees is the proportionate good.Mark: It's one aspect of pricing. All insurers care about is how much a policyholder is going to cost them. Birth-control pills make up a small fraction of an insurance company's annual costs. That is the most common form of birth control used by women who are twenty-nine and younger.

I think there's a bit of confusion between an analogy and a slippery slope argument. Indeed, what I wrote wasn't even strictly an analogy: I was asking one to imagine the exact same regulatory policy and arguments in support thereof, just with a slightly different subject matter.

So you've now gone from saying that tracing dollars is certainly necessary to saying that it's certainly not necessary to saying that you don't know what it means. Hmm. Anyway, I'm merely trying to discuss the same point on which you spent several paragraphs in your post (where you claimed that we can't know what happens to dollars after they are sent to insurance companies). If your real point is that the employer's will isn't directly involved, then talking so much about tracing dollars may have been a distraction, even to the point of causing you to forget what your own argument was!

Does anyone have a problem with the HHS proposal for Catholic hospitals, etc. who self-insure?(That means that instead of buying insurance they contract with a "Plan administrator" to manage heallth benefits using the hospital's money to pay the bills. The administrator is paid a fee for its management services). As proposed by HHS.1. The hospital's self-insured plan excludes coverage for contraception.2. HHS pays the same company the hospital chose as its Plan Administrator to provide "contraception-only" insurance to the hospital's employees and their dependents. This arrangement is between HHS and the Administrator and doesn't involve the hospital. That's a simplified description. For complete detail, see: https://www.federalregister.gov/articles/2013/02/06/2013-02420/coverage-... don't see any problem in that. Do you?The difference between this plan for self-insured employers and the one we have been discussing for employers who buy insurance is that it makes clear where the money to pay for contraception is coming from.

Mr. Time: I'm afraid you've lost me. Where did I say "tracing dollars" was certainly necessary? When I said I don't know what "tracing dollars" means, I was telling you I don't know what you mean by "tracing dollars." Buying insurance is not like buying bananas. There is not a 1:1 ratio between money spent and goods received. This fact seems to confound you, but grasping it is essential to having an intelligent conversation about the contraception mandate.

"The idea is that insurers will not lose money in the long run..."Grant --To be picky about this, perhaps losing money and not making as much money are not the same thing. Maybe the point here should be that the insurance companies simply won't make quite as much if they pay for the contraceptives, and that is not the same thing as losing money We say a company "is losing money" when it makes no profits at all.

The fact that one cant trace the exact dollars is neither here nor there. It certainly is both here and there at least if one is interested in making a Catholic moral argument.

If you didn't know what I meant by tracing dollars (or rather, if you had forgotten since writing your post's several paragraphs about tracing dollars), what made you state such a certain opinion about its relevance to Catholic moral argument? This seems an argumentative strategy designed to confuse.

That's not from my post; it's from a comment I left responding to your comment, "The fact that one cant trace the exact dollars is neither here nor there." I was guessing at your meaning, but this is a sideshow. Either you know how insurance works and you can engage in Catholic moral reasoning on this issue or you can't. Looks like the latter to me. I think we're done now.

I do know how insurance works, which is why I was surprised to see the claim that insurers set prices based on "risk assessment" rather than "services covered," as if the risk assessments in question aren't focused entirely on the risk that insured people will make claims for, well, the "services covered."

Anyway, Catholic moral reasoning is itself a sideshow. It might well be the case that if someone holds a gun to your daughter's head and says, "Choose between stealing a piece of bread or letting your daughter be shot," you can steal the piece of bread legitimately without willing the moral evil of theft. But that in no way answers the question here, which is whether you should be able to say, "I don't like stealing and I'd rather not be forced to make such a choice in the first place." So too here. Hobby Lobby is paying money to an insurance company and, by virtue of that payment, that insurance company is going to turn around and reimburse drug companies for contraception for Hobby Lobby employees (this is actual money flowing around, it's "free" only from the perspective of the Hobby Lobby employee when at the drugstore). The fact that Catholic moral reasoning might say, "OK, Hobby Lobby guy, you're not actually sinning," doesn't mean everything is cool. The Hobby Lobby guy still has the right to say, "I don't want to be put to such a choice in the first place."

Is this really so hard to grasp? Two groups have exactly the same policy. Group A comprises mostly people middle-aged and older. Group B comprises mostly people middle-aged and younger. Which group will have the higher premiums? That is what I'm talking about.Most insurers cover the same things. Premium pricing is governed by several things, including the likelihood of policyholders' requiring expensive medical treatment, whether they have already required expensive medical treatment, what kind of deductibles the group policyholder wants. If pricing were determined solely by services covered, buying insurance would be like buying lunch at McDonald's. In fact, it's a good deal more complex.

I don't think anyone ever said that premiums are determined solely by services covered, or even if they did, that it would have any moral relevance. That's a straw man. The moral objection to contraceptive coverage (or euthanasia coverage, or any other type of coverage to which you might imagine objecting) consists of this: "I'm paying money to an insurance company, and by virtue of that payment, the insurance company is offering reimbursement for something that I think evil." This moral objection has nothing to do with how the insurance company sets its prices. The objection is the same whether the insurance company raised its prices, lowered its prices, or charges everyone a flat fee. It is also the same even if the insurance company is "saving money" by offering the new coverage -- even if the company saves money on some other coverage item, the fact remains that it is spending money on the reimbursements here and now. There is no known economic principle whereby I get to claim that spending money on X is "free" merely because it prevents me from having to spend as much money on Y (I might be saving money overall, but that just means that I'm spending money on X rather than Y, it doesn't mean the absurdist conclusion that X is literally "free").

JohnRegarding self-insureds, weve already discussed, at some length, whether Catholic organizations are providing funds to the HHS to pay for contraception services. We have a profound disagreement on that, I think, but lets leave it aside for now.If I understand you correctly, a self-insured employers decision to hire an employee will thereby give that employee free contraception. I dont see how Catholic organizations could do that without directly cooperating in what the Church considers sinful. So, yes, I can see the bishops having a major problem with that. One could say the employee could get the same coverage from another employer, but I dont think that relieves the Church organization of its culpability as the proximate cause.

It seems to me that the most fundamental problem in this whole complex issue is -- and has been for a long time -- the nature of money -- specifically the nature of our kind of money, which has no intrinsic value (except for silver and gold coins) and which can be instantiated by both paper dollars which can be swapped for coins and for entries (numbers below or along side our names) in accounting ledgers of all sorts. (Yes, the figures in your account in your bank's data bank *are* money just as much as the dollar bills and pennies in your wallet.)So it's meaningless to talk about "tracing our money" as it goes into AND out of the pool of the ins. co,'s money. Once in the pool it isn't ours.So what IS ;money? Best I understand it it is proxy for something else. Specifically it is often a symbol (the coins, dollars, data in ledgers and computers etc.) which ultimately signify an agreement to do something or make an exchange. (It's more complicated than that, but for our purposes it might be descriptive enough to at least start a discussion.)The big problem about money in this thread is *the pooling of money*. We tend to talk as if "our" premiums paid by our employers with "their" cash/checks/whatever retain their metaphysical identity when the premiums are pooled in the databank of the insurance company. It seems to me it does not, at least not completely. It is still a symbol of an agreement to do or exchange something, but its character as *our* money or our employer's money had been total lost. The ins. co. is still bound to pay our claims, but the money which was my employer;s money becomes the insurance company's money to do with it as it sees fit. If the executives spend it on contraceptives or for booze for themselves is irrelevant.

In this series of posts, Grant wrote about whether the accommodated client's premium dollars are subsidizing its employee's contraception because he's responding to Matthew Frank. Franck spent a lot of time on this question at the First Thoughts blog. Franck's treatment could lead one to believe that the issue of client premium dollars flowing to the insurance company to the pharmacist is a major issue at stake. But I don't think Grant has ever believed that. His point, almost from the time the accommodation was first floated, is that at some point the cooperation by the employer becomes so remote that it is permissible. As I've commented a number of times, I don't think that's an unreasonable analysis. And inasmuch as the HHS mandate seems to be a fait accompli, I fully expect most Catholic universities and hospitals to reach the same conclusion.

Mark Proska wrote "If I understand you correctly, a self-insured employers decision to hire an employee will thereby give that employee free contraception. I dont see how Catholic organizations could do that without directly cooperating in what the Church considers sinful"Mark, OK, i can understand that view even though I don't agree with it. However, the President has been clear from the beginning that the goal has been to provide free contraception to employees - but to find a way that works best for non-profit employers with religious objections to contraception If you say that no scheme by which employees of Catholic hospitals, universities, etc end up with free contraception is acceptable - even if the employer does nothing other than hire or continue to employ them - I don't see that there is any productive negotiation you can have with HHS. I hope the USCCB doesn't take that approach.

"The big problem about money in this thread is *the pooling of money*. We tend to talk as if our premiums paid by our employers with their cash/checks/whatever retain their metaphysical identity when the premiums are pooled in the databank of the insurance company. It seems to me it does not, at least not completely. It is still a symbol of an agreement to do or exchange something, but its character as *our* money or our employers money had been total lost. The ins. co. is still bound to pay our claims, but the money which was my employer;s money becomes the insurance companys money to do with it as it sees fit. If the executives spend it on contraceptives or for booze for themselves is irrelevant."What's being described here as "the pooling of money" is the most fundamental characteristic of insurance itself: many individual entities who bear a similar type of risk (my ship may sink, my house may burn down, I may contract cancer) pay the insurer a relatively small amount of money (the "premium") with the understanding that some subset of them will make a claim on the insurer, perhaps for a comparatively large sum of money, as a result of a loss. Those premiums, once paid, may be put to any number of uses: some of it is used to pay claims, some of it may be parked as reserves to be ready to pay out expected future losses, some of it may be invested in other investments (insurance companies certainly are among the large institutional investors that essentially control the financial world - cf AIG), some of it covers operating expenses, some of it is paid as profits to the owners, and so on and so on.I suppose the point I am trying to make here is that the relationship between a premium being paid in and a claim being paid out is pretty opaque to an outsider. And as Grant has pointed out, the Obama administration has built a number of protections into the accommodation to shield the employer from culpability. I'm not a supporter of the mandate. It's a pretty raw (but, clearly, effective) scheme to buy votes, wrapped in a kimono of health care and compassion, and it takes away religious freedom from at least one class of employer (Hobby Lobby). It's a bad law. It should never have been enacted, and our society would be more just if it could be repealed. But if we are to measure gradations of persecution - well, things could be even worse.

However, the President has been clear from the beginning that the goal has been to provide free contraception to employees but to find a way that works best for non-profit employers with religious objections to contraception.John--In my view, this can be fairly translated as:The President has made clear from the beginning that he wants this to happen, he wants it to happen via the employer/employee relationship, he wants it to happen in a way that works best for religious organizations that have serious objections, but if they dont accept his view of what works best, he will seek to ram it down their throats.He cant say he wants to find a way that works best with the Churchs objections and then say their objections are baseless. It is for the Church, and the Church alone, to determine what is objectionable to the Church. Lets not forget: It was the Presidents decision to have the employer be the facilitator of this free coverage, not the Churchs. A tactical error on his part, borne of hubris. I hope the USSCB stands firm.

Jim Pauwels wrote : "The big problem about money in this thread is *the pooling of money*. We tend to talk as if our premiums paid by our employers with their cash/checks/whatever retain their metaphysical identity when the premiums are pooled in the databank of the insurance company. It seems to me it does not,"The problem is that most of us, somewhere, ran into a teacher who explained inurance by talking about Benjamin Franklin's insurance company in Philadelphia where 70 building owners got togetherand agreed that rather than each taking the risk that his building would burn down they would pool tneir risks. Each paid in some money and agreed that if anyone's building burned down, the group would pay to rebuild it. After a certain period of time, whatever money hadn't been used to pay claims would be given back to the people who had paid it in and a new group would be formed. The money held by the company really continued to be each person's money.That isn't what's happening whn I send a hevk to Commerce Insurance for fire insurance on my house. Commerce tells me how much they want to take off of my hands the risk that my house will burn down. If I agree to their price I am not entering into some league of homeowners who are sharing the risk that one our homes may burn down. The only one I am involved with is Commerce. i pay them X dollars and they promise to pay the cost of rebuilding my house if it burns down. The X dollars I give then is their money as soon as I hand it to them and isn't pooled with anything - it goes into their bank accounts and they can spend it for anything they want. If my house burns down, they will pay me what is needed to rebuild it, but it's their money they use to pay me, not some specially set-aside pool of money that I still have some interest in.

I'm interested in hearing whether anyone can offer more examples of this unprecedented principle of economics, whereby:1) At Time 1, I spend money on Y;2) At Time 2, I spend more money on X and less money on Y (because X prevents Y);3) Therefore, because the shift in spending is cost-neutral, there is actually ZERO money spent on X and I can say that X is "FREE"!!!!Is this principle like Bush v. Gore, good only for the current case and never to mentioned again?

Mr. Wasting Time, I have not heard anyone propose that principle. The "I" in your points 1 and 2 is an insurance company, not the employerThe version of your point 3 that has been proposed by HHS is:3) If the total spent in point 2 is the same or less than in point 1, I (the insurance company) can give the items purchased with X without charge to people who would otherwise cause me to spend more money on Y. From their standpoint the items are free. Note that the items are not free to the insurance company. It spent X for them.

Going back to your post before that one, the employer is not paying "for the insurance policy by virtue of which the items are being provided to employees."The employer is paying for a policy that excludes coverage for contraceptives. The insurance company provides contraceptives to employees under another insurance policy in which the employer has no part.

But that arrangement is an elaborate charade. After all, it's not as if a given insurance company is going to offer the "free" coverage (for which it pays out money in reimbursements) to any business's employees until and unless the business pays for such a (supposedly separate) health insurance policy for those specific employees.

Mr. Wasting Time. OK, I'll revise my sttement from yesterday to inlude insuranceIf you say that no scheme by which employees of Catholic hospitals, universities, etc end up with free contraception is acceptable even if the employer does nothing other than hire or continue to employ them AND PROVIDE HEALTH INSURANCE EXCLUDING CONTRACEPTION I dont see that there is any productive negotiation you can have with HHS. I hope the USCCB doesnt take that approach.

The health insurance doesn't "exclude contraception" if there is a mandate that all policies are automatically accompanied by contraceptive coverage provided by the same health insurance company that the employer pays and provided to the same employees (no one else) who are covered by the contract. I find it hard to imagine that anyone actually believes this charade, who isn't paid to say so.

Oh my, I didn't mean to cast any aspersions on present company. So sorry if it came across that way.I was just expressing surprise that anyone outside the administration would actually believe the claim that if we merely tell ourselves strenuously enough (a la Dorothy in the Wizard of Oz) that there really is a "separate" policy for contraceptive coverage, then when real insurance companies pay real money to real drug companies for real contraception, that money somehow has no connection whatsoever to the underlying insurance policy by virtue of which this "separate" coverage sprang into existence. It's as if the money that pays for contraception is, from now on, going to be generated out of thin air, as if from an economic perpetual motion machine.

"If you say that no scheme by which employees of Catholic hospitals, universities, etc end up with free contraception is acceptable even if the employer does nothing other than hire or continue to employ them AND PROVIDE HEALTH INSURANCE EXCLUDING CONTRACEPTION I dont see that there is any productive negotiation you can have with HHS."The HHS certainly has remedies at its disposal that would go farther than it has to appease the bishops and others who object to the proposed accommodation.One obvious one would be to expand the definition of religious entities, such that Catholic universities and hospitals are classified as religious entities. That would dispense with the need for any accommodation for them.Another possibility, suggested from a number of quarters, would be to incorporate private employers with faith-based objections, like Hobby Lobby, under the same accommodation being proposed for Catholic universities and hospitals.And of course, best of all would be to rescind the HHS mandate in its entirety.All of these courses of action are available to HHS. That it has shown not the slightest inkling of pursuing any of them suggests to me that HHS is intransigent and obtuse in this alleged negotiation.